Organization
AMERIGROUP NEW YORK, LLC
Active
Other names
AMERIGROUP Community Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER D. HAYTAIAN (PRESIDENT AND CEO)
(212) 563-5570
Entity
Organization
Contact information
Practice address
360 W 31ST ST, 5TH FLOOR, NEW YORK, NY 10001-2727
(212) 563-5570
(212) 563-5975
Mailing address
360 W 31ST ST, 5TH FLOOR, NEW YORK, NY 10001-2727
(212) 563-5570
(212) 563-5975
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
04-008
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01617894
—
NY
01
—
02644562
MLTC PROVIDER ID
NY
01
—
04-008
DOH HMO NUMBER
NY
Enumeration date
12/01/2005
Last updated
07/30/2007
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